Adenomyosis and Infertility: Everything You Need to Know
Adenomyosis is a condition where the tissue that normally lines the inside of the uterus (the endometrium) starts growing into the muscle wall of the uterus. This condition can contribute to infertility by distorting the structure of the uterus in ways that affect implantation of the embryo, and by causing inflammation.
In this article, we explore the relationship between adenomyosis and infertility and the treatment options available to those seeking to start or grow their families.
What is Adenomyosis?
Adenomyosis is a condition where the tissue that normally lines the inside of the uterus starts growing into the muscle wall of the uterus, at least 2.5 mm deep. This often causes the uterus to become larger than normal. In some cases, the condition also affects the blood vessels and lymphatic channels within the uterus.
Ages Most Affected
Most cases of adenomyosis are found in women in their 40s and 50s, but 5–25% of cases occur in women under the age of 39.
Co-Occurrence with Other Conditions Affecting Infertility
Recent studies have shown that adenomyosis often occurs alongside other conditions, including fibroids (in 35–55% of cases) and endometriosis (in 65–70% of cases).
What Are the Symptoms of Adenomyosis?
Though adenomyosis can have negative impacts on fertility, and present as various uncomfortable symptoms, approximately one-third of women with adenomyosis are asymptomatic, and go undiagnosed.
Women who are symptomatic may experience :
- Prolonged or heavy menstrual periods
- Intense menstrual cramps or sharp pelvic pain during menstruation
- Ongoing pelvic discomfort
- Pain during intercourse
- A feeling of pressure or tenderness in the lower abdomen, often from an enlarged uterus
How Does Adenomyosis Impact Fertility?
Adenomyosis can impact fertility by distorting the normal structure of the uterus, impeding the movement of sperm, disrupting the natural contractions of the uterine muscles, and increasing inflammation. Women with adenomyosis may also have hormonal imbalances, higher levels of oxidative stress, and changes in key genes important for embryo development, all of which negatively impact fertility.
Source: Pados G, Gordts S, Sorrentino F, et al. Adenomyosis and infertility: A literature review. Medicina (Kaunas). 2023;59(9):1551. doi:10.3390/medicina59091551.
What is the best treatment for adenomyosis?
Adenomyosis affects each woman differently, and the best treatment depends on factors like the type and severity of your symptoms, your age (since adenomyosis often improves after menopause), effects of previous treatments, personal preferences, and whether you plan to have children. Treatment options include :
- Hormonal therapies that help regulate menstrual cycles and reduce adenomyosis symptoms. These include oral contraceptives and/or gonadotropin-releasing hormone (GnRH) antagonists or agonists.
- Assisted reproductive technologies (ART), including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), can help bypass the fertility issues associated with adenomyosis. Sometimes, hormonal suppression will be used before an embryo transfer to help treat the inflammation associated with adenomyosis.
- UAE (Uterine Artery Embolization): A minimally invasive procedure that blocks blood flow to adenomyosis tissue, causing it to shrink. This option is ideal for women with large uteri or multiple fibroids, particularly when pregnancy is not a goal.
- RFA (Radiofrequency Ablation): Best for focal adenomyosis, especially for women who want to preserve fertility.
- HIFU (High-Intensity Focused Ultrasound): Considered for localized adenomyosis, particularly in the anterior uterine wall.
- Anti-inflammatory medications and pain relievers: Ibuprofen can help with pain and heavy bleeding. Sometimes, it is recommended to start these medications a few days before your period and continue during your cycle.
When To Treat Adenomyosis in Relation to Fertility Treatment
Whether or not adenomyosis should be treated before pursuing treatments like IUI or IVF depends on its severity.
If you have adenomyosis and have already experienced a failed IVF cycle, it is likely that your adenomyosis should be treated before pursuing another cycle.
In general, adenomyosis treatment is often recommended before starting fertility treatments like IVF, especially if symptoms are severe or if the condition significantly impacts the uterine environment.
Adenomyosis and Infertility: The Takeaway
Adenomyosis is a condition where the uterine lining tissue grows into the muscle wall, often affecting fertility by altering the uterus’s structure and causing inflammation. It can co-occur with other conditions that impact fertility, like fibroids and endometriosis.
Treatment options vary, from hormonal therapies and pain management to more advanced procedures like Uterine Artery Embolization (UAE), Radiofrequency Ablation (RFA), and High-Intensity Focused Ultrasound (HIFU).
Schedule a consultation today and start your personalized treatment plan.
